360 Background: Retrospective population-based studies have shown that an interval longer than 12 weeks between diagnosis and cystectomy is associated with worse outcomes in patients with muscle-invasive bladder cancer (MIBC). Neoadjuvant chemotherapy (NAC) is widely used however the impact of duration from diagnosis to cystectomy is unclear in MIBC patients treated with NAC. Methods: We performed a retrospective analysis of patients with MIBC who received NAC followed by cystectomy between 1996 and 2014 at a single institution. Total therapy duration was defined as the time interval between diagnosis of MIBC on biopsy and the date of cystectomy. Cox proportional hazards regression models were used to investigate the effect of total therapy duration and other factors on overall survival (OS). Results: 201 patients who met the study criteria were analyzed.Demographics included: median age 62, 79% male, 62% cT2N0, 10% cN+, 29% w/variant histology (VHx). Cisplatin-based therapy was given to 91% of patients for a median of 3 cycles. The median time from diagnosis to the cystectomy was 28 weeks. A total therapy duration < 28 weeks did not impact OS (hazard ratio [HR], 0.68; p=0.39). Pretreatment clinical covariates associated with improved OS included age< 62 (HR 0.56; p=0.034) and absence of VHx (HR, 0.40, p=0.001). Post-treatment factors of significance included less than 3 cycles of chemotherapy received (HR 1.75, p=0.037), pT3/T4 or N+ (HR 5.18, p<0.001), and N- (HR 0.58, p=0.048). Conclusions: Total therapy duration does not significantly impact OS in patients with MIBC receiving NAC. This data adds to the evidence supporting the use of NAC in MIBC patients fit to receive cisplatin-based regimens.
Outcomes of neoadjuvant chemotherapy using gemcitabine and cisplatin in muscle invasive bladder cancer: A retrospective analysis of the patient and treatment factors in a single institute
